Venous thromboembolism in patients with symptomatic atherosclerosis

2011 ◽  
Vol 106 (12) ◽  
pp. 1095-1102 ◽  
Author(s):  
Samuel Goldhaber ◽  
Darleen Lessard ◽  
Robert Goldberg ◽  
Catherine Emery ◽  
Frederick Spencer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Population Based ◽  
Major Surgery ◽  
Atherosclerotic Cardiovascular Disease ◽  
Increased Risk ◽  
History Of ◽  
Artery Disease

SummaryPatients with atherosclerosis have an increased risk of venous thromboembolism (VTE). We studied patients in the population-based Worcester VTE Study of 1,822 consecutive patients with validated VTE to compare clinical characteristics, prophylaxis, treatment, and outcomes of VTE in patients with and without symptomatic atherosclerotic cardiovascular disease, defined as history of ischaemic heart disease, history of positive cardiac catheterisation, percutaneous coronary intervention, or coronary artery bypass graft surgery, or history of peripheral artery disease. Of the 1,818 patients with VTE, 473 (26%) had a history of symptomatic atherosclerosis. Patients with atherosclerosis were significantly older (mean age 71.9 years vs. 61.6 years) and were more likely to have immobility (57.2% vs. 46.7%), prior heart failure (36.9% vs. 10.7%), chronic lung disease (26.4% vs. 15.5%), cerebrovascular disease (18.1% vs. 9.8%), and chronic kidney disease (4.9% vs. 1.9%) (all p<0.001) compared with non-atherosclerosis patients. Thromboprophylaxis was omitted in more than one-third of atherosclerosis patients who had been hospitalised for non-VTE-related illness or had undergone major surgery within the three months prior to VTE. Patients with atherosclerosis were significantly more likely to suffer in-hospital major bleeding (7.6% vs. 3.8%, p=0.0008). In conclusion, patients with atherosclerosis and VTE are more likely to suffer a complicated hospital course. Despite a high frequency of comorbid conditions contributing to the risk of VTE, we observed a low rate of thromboprophylaxis in patients with symptomatic atherosclerosis.

Have we learnt all from IMPROVE-IT? Part II. Subanalyses on the ef- fects of ezetimibe added to statin therapy on selected clinical and laborato- ry outcomes, cost effectiveness, guideline and clinical implications

2020 ◽  
Vol 18 ◽  
Author(s):  
Zlatko Fras ◽  
Dimitri P. Mikhailidis
Keyword(s):  
Statin Therapy ◽  
Artery Bypass ◽  
Low Density Lipoprotein ◽  
Bypass Graft ◽  
Density Lipoprotein ◽  
Drug Discontinuation ◽  
Atherosclerotic Cardiovascular Disease ◽  
History Of ◽  
Risk Cost ◽  
Cardiovascular Biomarkers

: In this second part of a review of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), we discuss the findings in relation to patients with stroke, the ACS phenotype, history of coronary artery bypass graft surgery, heart failure, concurrent polyvascular atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus, and different levels of expression of selected cardiovascular biomarkers. The combination therapy was proven safe, and drug discontinuation rates were not increased by adding ezetimibe. Since both statins and ezetimibe are now almost globally generically available, we can conclude that for secondary prevention of ASCVD, adding ezetimibe to high-intensity statin therapy further reduces low-density lipoprotein cholesterol (LDL-C) and cardiovascular risk cost-effectively.

scholarly journals Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study

2020 ◽  
Vol 65 (7) ◽  
pp. 454-462 ◽  
Author(s):  
Tanya S. Hauck ◽  
Ning Liu ◽  
Harindra C. Wijeysundera ◽  
Paul Kurdyak
Keyword(s):  
Myocardial Infarction ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Population Based ◽  
Geographic Region ◽  
Time Varying ◽  
The Impact ◽  
The Relationship

Background: Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. Aims: To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. Method: This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. Results: A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). Conclusions: In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.

P6516The association between prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention (PCI): an observational study of 123,780 patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Beirne ◽  
K Rathod ◽  
A Jain ◽  
A Mathur ◽  
A Wragg ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Bypass Grafts ◽  
Percutaneous Coronary ◽  
History Of

Abstract Background Limited information exists regarding procedural success and clinical outcomes in patients with previous CABG undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without previous coronary artery bypass grafts (CABG). Methods This was an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry, from January 2005 to December 2015. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (interquartile range 1.2–4.6 years). Results 12,641 (10.2%) patients had a history of previous CABG, of whom 29.3% (n=3,703) underwent PCI to native vessels and 70.7% (n=8,938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%) (p=0.0005) compared to patients with no history of prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%, p<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (HR 1.02, 95% CI 0.77–1.34; P=0.89) but a significant increase in mortality among patients with PCI to bypass grafts (HR 1.33 95% CI 1.03–1.71, P=0.026). This was seen after multivariate adjustment and propensity matching. Figure 1. Kaplan-Meier Curves Conclusion Patients with prior CABG are older, with a greater comorbid burden and more complex procedural characteristics, but after adjustment for these differences clinical outcomes are similar to patients undergoing PCI without prior CABG. In these patients, native vessel PCI was associated with better outcomes compared to the treatment of vein grafts.

Conceptual Framework of Collateral-promoting Therapy for Coronary Artery Disease

2011 ◽  
Vol 3 (1) ◽  
pp. 45
Author(s):  
Masatoshi Fujita ◽  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Whole Body ◽  
Coronary Collateral ◽  
Collateral Growth ◽  
Periodic Acceleration ◽  
Artery Disease ◽  
Macrophage Colony

Human coronary collateral circulation (CCC) serves as an alternative blood-conveying circuit to the ischaemic myocardium. Functional potentiation of CCC is considered as a therapeutic approach in patients with intractable angina for whom revascularisation procedures such as percutaneous coronary intervention and coronary artery bypass graft surgery are not indicated. Augmentation of CCC is established by collateral recruitment and growth. Nitrates and sarpogrelate are representative drugs that enhance collateral recruitment. Exercise, enhanced external counterpulsation and whole-body periodic acceleration accelerate and potentiate collateral growth via increased mechanical stress at pre-existent collateral arterioles. Granulocyte macrophage colony-stimulating factor and heparin favourably modulate the cascade of coronary collateral growth. Further experimental and clinical studies will be needed to create more sophisticated coronary collateral-promoting therapies.

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